Vol 2-3 Case Report

Beyond the Shoulder: A Case Report of Regional Interdependence Treatment Approach in an Elite Level Tennis Player

Spencer W. Sullivan*, Ioonna Félix

Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA

This clinical case presents an elite level 23-year-old female tennis athlete with a high-grade partial thickness tear of the supraspinatus with associated pain, dysfunction, and deficits in strength and range of motion (ROM) of her trunk and lower extremities. The purpose was to determine the efficacy of using a regional interdependence approach in the treatment of a partial supraspinatus tear with associated kinetic chain deficits in an elite level athlete. Following 24 physical therapy sessions, pain, mobility (ROM), strength, and function improved in the dominant shoulder in addition to further symmetry of the trunk and lower extremity due to a regional interdependence rehabilitation approach and returned to elite level of play. As a result of this case, it is important for clinicians to consider a comprehensive, global approach to patient rehabilitation following injury.

DOI: 10.29245/2767-5130/2021/3.1147 View / Download Pdf
Vol 2-3 Commentary

Commentary: “An Imaging Overview of the Posterior Septum of the Knee and Trans-Septal Portal Procedure: Normal Anatomy, Indications, and Unique Imaging Considerations”

Jay Moran1, Mark D. Miller2, Michael J. Medvecky1*

1Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA

2Department of Orthopaedics, University of Virginia, Charlottesville, VA, USA

DOI: 10.29245/2767-5130/2021/3.1148 View / Download Pdf
Vol 2-3 Commentary

Commentary: Management of Refractory Pain After Total Joint Replacement

Jamie Heimroth1*, Max L. Willinger1, Nipun Sodhi1, Luke J. Garbarino1, Peter A. Gold1, Jonathan R. Danoff2, Sreevathsa Boraiah2

1Department of Orthopedic Surgery, Long Island Jewish Medical Center, Queens, NY, USA

2Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY, USA

Chronic refractory pain after total joint replacement is debilitating and a source of dissatisfaction for patients. The management of pain following total joint replacement varies during the acute postoperative period compared to the 3 months postoperative at which point the pain is considered chronic pain. Acute postoperative pain relief programs have seen promising results with multimodal pain control through the use of combinations of opioids, acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids and ketamine. The addition of regional blocks to the multimodal regimen has improved acute postoperative pain control following total joint replacements. On the other hand, chronic pain can be successfully managed with options including genicular nerve radioablation therapy (GN-RFA), neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), and peripheral subcutaneous field stimulation (PSFS). While there is still minimal data on chronic pain relief regimens, meta-analyses and case reports have demonstrated the effectiveness and promising outcomes. This paper aims to evaluate the current medications and treatment options for managing refractory pain following TJA.

DOI: 10.29245/2767-5130/2021/3.1143 View / Download Pdf
Vol 2-3 Case Report

Obstetric fracture of the femur during cesarean section in a preterm baby: A case report

Freddy Mertens Bombah¹*, Alphonse Ngalame², René Essomba³, Yannick Ekani Boukar², Enrique Zoa Nkoa4, Daniel Handy Eone4

1Department of Surgery and Specialty, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon

2Department of Gynecology and Obstetrics, Faculty of Health Sciences, University of Buea, Cameroon

3Department of Surgery and Specialty, Higher Institute of Medical Technology, University of Douala, Cameroon

4Department of Surgery and Specialty, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon

Introduction: Obstetric fractures or Birth fractures are rare events following childbirth. Although fracture of the femur is a relatively uncommon injury, it is the most common fracture of the lower extremity in the newborn. Since evolution of cesarean section rates in Africa, it is one of the most commonly practiced modes of delivery for breech. We described one case of fracture of the femur at cesarean section treated at Adlucem hospital in bonabéri-Douala (Cameroon).

Case report: A 2.1 kg male infant was delivered by lower segment cesarean section for breech presentation. Clinical and radiological examination showed shaft fracture of femur with good evolution.

Discussion: Fractures of the long bones are associated with cesarean section, breech delivery with assistance and low birth weight. Femoral fractures are the most associated long bones fracture with cesarean section.

Conclusion: The clinical and paraclinical diagnosis is simple and the management is mostly non-operative. It is important to explain to the parents and especially to the mother the benignity of the lesion.

DOI: 10.29245/2767-5130/2021/3.1150 View / Download Pdf
Vol 2-3 Case Report and Review Article

Tibial Tubercle Avulsion Fractures in Adolescents: A Narrative Review & Case Report

Gregory W. Kunis1*, Joshua A. Berko1, Jeffrey C. Shogan1, Joshua B. Sharan1, Derek Jones2

1Nova Southeastern University, Kiran C. Patel College of Osteopathic Medicine, Florida, USA

2Department of Orthopedic Surgery, Broward Health, Florida, USA

Intro: Tibial tuberosity avulsion fractures are rare fracture patterns accounting for less than 1% of all pediatric fractures. These fractures occur when there is a sudden unbalancing of forces through the patellar tendon that separates the tibial tubercle from the anterior portion of the proximal tibia. These forces are commonly introduced in sporting activities and show a predominance for adolescent males. Treatment with open reduction internal fixation commonly results in favorable outcomes with minimal complications. In this presentation, we explore a case of a tibial tuberosity avulsion fracture and give an in-depth review of all aspects concerning this fracture pattern.

Case Description: A 14-year-old male with no significant past medical history presented via emergency medical services after a ground level fall while playing basketball. Radiographs of the left knee and tibia revealed an Ogden Type III, distracted avulsion fracture of the tibial tuberosity with suprapatellar effusion. Surgical intervention was achieved through open reduction internal fixation of the left tibial tubercle.

Discussion: Although a relatively rare fracture pattern, this case demonstrates a classic presentation and treatment of a tibial tuberosity avulsion fracture. This case serves as a reminder that despite the rarity of the injury, a clinician with an appropriate index of suspicion can accurately diagnose and treat this fracture and achieve positive outcomes in returning the patient to pre-injury activities. For those reasons, we provide a comprehensive overview of all aspects regarding this fracture pattern including the anatomy, embryology, mechanism of action, predisposing conditions, treatment considerations, complications and associated injuries.

DOI: 10.29245/2767-5130/2021/3.1149 View / Download Pdf